Kaiser Permanente Configuration Analyst IV in Rancho Cucamonga, California
The Configuration Analyst will understand the types of provider contracting arrangements &/or benefits administration data elements that need to be configured in the existing application (the host processing system), & other platform applications to support the accurate & timely payment of claims for the Regions' Claims systems. Tests new releases, makes recommendations on system enhancements, & evaluates contracts for configuration which includes system capabilities. Consults w/appropriate internal partners on issues of interpretation. The Configuration Analyst works w/the Product Mrgs & Developers to define, code, configure & maintain detailed provider/benefit services & provider/benefit plans designs for the applications that require benefit information. The Configuration Analyst helps to bring products to market that meet customer (e.g., member, broker, consultant, employer, etc.) needs & expectations & ensures that product & operational goals are achieved. The Configuration Analyst makes sure benefits are well defined & can be configured in all applications that require benefit data/provider contract data. The incumbent provides consultation & support to all other employees responsible for configuring benefits into KP benefit systems. The incumbent also ensures that the benefit coding definitions are consistent across the organization. The incumbent will provide subject matter expertise throughout the organization for benefit coding, billing & benefit configuration & ensure consistency & compliance of benefit coding definitions across applications. The Configuration Analyst clearly understands the products & healthcare benefit services offered to our customers, including cost share, limits, accumulators, & regulatory rules & guidelines. The Configuration analyst function will leverage applicable components of the Product Development Management Process (PDMP) or similar processes & Comprehensive Delivery Process (CDP) or similar processes to bring KP products to the market.
Essential Functions: - Includes all responsibilities of the Configuration Analyst II & III. - Provides technical coding & design advice for benefit development in support of product initiatives so that applicable PDMP approval gates or similar approval gates are met & the product plan remains on track (green) status. - Provides expert knowledge, impact analysis & recommendations related to configuration design & understanding impacts of benefit data/provider contract data on all systems that require benefit data/provider contract data & frequently act as a liaison, problem solver & facilitator. - Creates &/or socializes coding definitions for all benefit designs. This work includes tools for project governance, tools & templates, protocols, engagement strategy, escalation protocols, decision-making, risk management & contingency planning. - Develops processes to analyze, design, configure, code & QA detailed benefit designs & provides assistance to all departments on benefit coding issues. - Ensures correct interpretation & definition of benefits. - Develops benefit codes & ensures integration w/across all product lines. - Creates &/or manages project plans & timelines to ensure that a given product plan will produce desired results for the targeted market segment & regional operation &/or to meet broader product solutions which would be developed for segment specific strategies. - Identifies & seeks approval for key actions necessary to remediate all problems/issues & makes recommendations to management on steps to ensure product is delivered on time w/in specifications. - This job description is not all encompassing.
Qualifications: Basic Qualifications: Experience - Minimum six (6) years of benefit configuration/coding experience. - Minimum five (5) years in health care or managed care. - Minimum three (3) years of experience in documentation, research and reporting required. Education - High School Diploma or General Education Development (GED) required. License, Certification, Registration - Medical and billing coding certification required.
Additional Requirements: - Expert knowledge in Claims and provider contracts in the appropriate Regional Claims system. - Understanding of relational databases. - Thorough knowledge of policies, practices and systems. - Complete understanding and application of principles, concepts, practices, and standards. - Full knowledge of industry practices. - Broad application of principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields. - Thorough knowledge of benefits, benefit administration and health care delivery from either/both a payor or provider perspective, along with insurance industry practices and systems. - Excellent interpersonal, communication, and listening skills are required. - Demonstrated competency in medical coding, medical terminology, claims processing, logical thinking and understanding of relational database is required. - Knowledge of state and federal regulations - Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g. partnering, conflict management, consulting, etc.). - Advanced proficiency in Microsoft Excel. - Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications: - Minimum four (4) years of experience of related Health Plan, Medical Group, hospital or insurance analytical and/or consulting experience preferred. - Experience with Center for Medicaid and Medicare (CMS) regulatory guidelines preferred. - Bachelor's degree in information systems, business or health care administration, or other related field, preferred. - Master's degree preferred. - EPIC Benefit Engine, Tapestry AP claims or Diamond claims desirable. - Intermediate proficiency in Microsoft Access and Query Tools preferred. - Basis proficiency in statistical analysis preferred.
COMPANY Kaiser PermanenteTITLE Configuration Analyst IVLOCATION Rancho Cucamonga, CAREQNUMBER 601120
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.